Objective: Functional impairment is a major determinant of long-term outcomes in schizophrenia and is influenced by multiple clinical and cognitive factors. Although formal thought disorder (FTD) has been associated with adverse outcomes, its relationship with functioning in patients with schizophrenia and a history of violent offending remains unclear. This study investigated the relationships among FTD, executive functioning, and personal and social functioning in this population.
Methods: This cross-sectional study included 64 inpatients with schizophrenia and a history of violent offending. Psychopathology was assessed using the Positive and Negative Syndrome Scale (PANSS), depressive symptoms using the Calgary Depression Scale for Schizophrenia (CDSS), formal thought disorder using the Thought and Language Disorder Scale (TALD), executive functioning using the Frontal Assessment Battery (FAB), and personal and social functioning using the Personal and Social Performance Scale (PSP). Spearman correlation and multiple linear regression analyses were performed to identify factors associated with functioning.
Results: Poorer functioning was associated with greater psychopathology and more severe FTD. Subjective negative thought disorder showed the strongest associations with poorer functioning, including socially useful activities, interpersonal relationships, and self-care (all p<0.01). Executive functioning, particularly verbal fluency, was positively associated with functioning; however, subjective negative thought disorder remained the only independent predictor of PSP total scores (β=-0.324, p=0.032).
Conclusion: Formal thought disorder, particularly its subjective negative dimension, appears to be an important determinant of personal and social functioning in patients with schizophrenia and a history of violent offending. These findings highlight the importance of assessing thought disorder beyond overall symptom severity and suggest that interventions targeting communication and thought organization may support functional recovery in forensic schizophrenia populations.